The measurement of resident and family satisfaction with life in the nursing home is vital if nursing home care is to be improved. We have demonstrated in a Phase I proposal that we can successfully collect satisfaction information from 79% of nursing home residents using simple questions within an interview strategy that considers the dementia and frailty of the nursing home population. Furthermore, we have developed a decision rule based on Minimum Data Set data that identifies those residents who are able to provide accurate descriptions of care activities that occur. We estimate that 48% of the nursing home population is accurate. This Phase II proposal extends this research in several important ways. First, we will work with 1OO nursing homes so as to analyze the stability of the satisfaction data over time and to establish the foundation for bench marking. Second, we will determine how the responses of both accurate and inaccurate residents relate to other measures of nursing home quality. Finally, we will develop a technological base that will permit us to efficiently collect data and sell our system to large numbers of nursing homes. We have support from a national nursing home professional association to increase the commercial viability of our system. PROPOSED COMMERCIAL APPLICATION: The goal of Quality of Life Systems is to provide a service to NHs, third party payors, managed care organizations, and the public at large, that will produce non-biased resident and family satisfaction data. While a number of competitors are developing NH resident and family satisfaction products at this time (Press-Ganey, and the Maryland Hospital Association), these products are all deficient in their ability to access information from even the mildly cognitively impaired and/or propose systems of data collection unworkable in Nhs, i.e., observation, self- administered surveys. We have had access to each product and have critiqued them in comparison to our own. These competitive products have questions at too high a reading level, are too abstract, focus on many issues that NHs do not have the power to change, cannot be self- administered as proposed, and are extremely lengthy. The labor intensity of face-to-face interviews, which is how our data will be collected, is necessary for the NH population, and will be counterbalanced by automation proposed for development in Phase II. Our product has received a great deal of exposure due to the interest of the American Association for Home and Services for the Aging representing over 5,000 non-profit NHs. In fact, AAHSA has contracted with us to conduct a field trail of 50 NHs in various regions throughout the country. In addition, third party payors have contacted us requesting to test our product. We plan to develop and test products for other levels of long term care (e.g., home health, adult day care, assisted living, residential care, etc.). There are 20,000 NHs in the United States. Capturing even one-tenth of the market share would result in a very viable business. It is anticipated that an NH would pay $5000 per administration of resident and family satisfaction instruments. Projected cash flow analysis shows a profit of over $200,000 for a volume of 400 homes, based upon annual measurement. Once the business is profitable, small NHs could join consortia to receive services at a fee more affordable to them.